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,L. <br />~~ <br />•- T <br />~~ <br />112 Enclosure <br />Permittee Name: Albert Frei 6 Sons, Inc. <br />Permit No: M-77-526 <br />Operation Name: Worthing Pit <br />Anniversary Date: 03 / 28 / 87 <br />Please complete the following and return this form with your fees <br />and reclamation data. <br />Enclosed are: Check space(s) below <br />_~ Check or money order payable to Colorado Mined Land Reclama- <br />tion Division for annual fees due <br />7C~ Annual Report <br />}CAL Map <br />Remarks: <br />,,/~// <br />~ v~ <br />Signature Albert R, Frei, President <br />